Aanesthetic Agents for Day Surgery - NIHR Health Technology ...

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134 Appendix 4 TABLE 66 contd Summary of adult clinical outcomes studies Study Investigations and subjects Outcome Results Conclusions and measures grade of evidence Short et al., 1985, (1) Methohexitone, alfentanil, N2O, O2 (a) Time to Group 2 abandoned after Grade I 122 UK (n = 20: 14 women, 6 men) open eyes 11 patients due to poor conditions during induction Method of randomisation RCT (2) Methohexitone, isoflurane, O2 (n = 20: 8 women, 3 men) (b) Time to recall date (a): (1) 9.2, (3) 9.1 min; not reported of birth p < 0.01 Not blind (3) Methohexitone, isoflurane, N2O, O2 (n = 20: 10 women, 10 men) (c) Time to (b): (1) 9.9, (3) 9.7 min; The majority of group 2 recall name p < 0.01 patients were not able to N2O: given in groups 1 and 3 complete the trial (d) Post-box (c): (1) 9.5, (3) 9.6 min; Premedication: none test p < 0.01 Procedures: D&C, cystourethroscopy (e) P-deletion (d): (1) 34.3, (2) 44.3, (3) 40.3; Age: > 18 years; mean (1) 45, (2) 46, test p < 0.01 group 2 (3) 43 years (e): (1) 4; (2) 2; (3) 2; NS Sivalingam ASA grade I or II LMA insertion Satisfactory or excellent: (1) Grade I et al., 1999, 123 (quality for 64%, (2) 64%, (3) 100%, (4) Singapore (1) Propofol 2.5 mg/kg + 10 mg induction only): 88%; p < 0.001 Method of randomisation increments i.v. (n = 25) excellent, not reported RCT satisfactory (2) Sevoflurane 8% + 60% N 2O vital or poor Open capacity breath (n = 25) (3) Sevoflurane as (2) + alfentanil 5 µg/kg (n = 25) (4) Propofol as (1) + alfentanil 5 µg/kg (n = 25) N 2O: given in groups 2 and 3 Premedication: none Procedures: mixed Gender: 55% men Sloan et al., 1996, Age: 16–65 years (1) Sevoflurane/sevoflurane + N2O (n = 25) (a) Open eyes (a): (1) 8.1, (2) 10.6 min Grade I 124 USA (2) Isoflurane/isoflurane + N2O (n = 25) (b) Obey (b): (1) 8.0, (2) 9.9 min Method of randomisation RCT command not reported N2O: given (c): (1) 9.9, (2) 12.6 min (c) Orientation Not blind Premedication: none (d): (1) 120, (2) 133 min (d) Discharge Procedures: not reported (e): Data not given (e) DSST Age: 18–76 years No difference between groups Smith and Thwaites, (1) Sevoflurane./sevoflurane (n = 30) (a) Open eyes (a): 7.1 min; p = 0.027 Grade I 1999, 125 (2) Propofol TCI (n = 31) (b) Date of (b): 8.1 min; NS Method of randomisation: England birth computer-generated N2O: not given (c): 100 min; p = 0.024 random numbers RCT (c) Sit up Premedication: none (d) Walk (d): 175 min; NS Blind Procedures: mixed (e) Street fit (e): 193 min; p = 0.005 Gender: 66% women Age: 18–73 years (f) PONV (f): (1) 9%; (2) 1%; p = 0.006 continued
TABLE 66 contd Summary of adult clinical outcomes studies © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Health Technology Assessment 2002; Vol. 6: No. 30 Study Investigations and subjects Outcome Results Conclusions and measures grade of evidence Song et al., (1) Propofol, desflurane + N 2O (n = 40) (a) Awaken (a): (1) 4.7, (2) 5.2, (3) 8.3 min; Grade I 1998, 126 USA p < 0.05 (no difference between (2) Propofol, sevoflurane + N 2O (n = 40) (b) Orientation groups 1 and 2) Method of RCT randomisation (3) Propofol TIVA + N 2O(n = 40) (c) Home-ready (b): (1) 9.8, (2) 11.3, (3) 14.7 min; not reported p < 0.05 (no difference between N 2O: given (d) Discharge groups 1 and 2) Not blind Premedication: none (e) PONV (c): (1) 140, (2) 143, (3) 149 min Procedures; laparoscopic tubal ligation (d): (1) 188, (2) 176, (3) 173 min Mean ± SD age: 30 ± 5 years (e): (1) 12%, (2) 8%, (3) 4% Groups 1 and 2 to group 3 Sukhani et al., (1) Propofol TIVA, atracurium, IPPV, (a) Open eyes (a, b): Significantly shorter in Grade I 1994, 127 USA N 2O (n = 34) group 2 (no data given); (b) Orientation p < 0.05 Method of RCT (2) Propofol TIVA, atracurium, IPPV, randomisation no N 2O (n = 36) (c) Ambulation (c, d): No difference not reported (no data given) N 2O: given in group 1 (d) Discharge Not blind (e): No differences. Early (1) Premedication: none (e) PONV 1–8%, (2) 2–6%; over 24 h (1) 1–13%, (2) 2–6% Procedures: gynaecologic laparoscopy Age: 19–40 years Sukhani et al., (1) Propofol TIVA + N 2O + fentanyl (a) Open eyes (a, b): No difference Grade I 1996, 128 USA (n = 40) (b) Orientation (c, d): Group 2 shorter; Method of RCT (2) Propofol TIVA + N 2O + ketorolac p < 0.05 randomisation (n = 40) (c) Ambulation not reported (e): (1) 20%, (2) 11%; p < 0.05 N 2O: given (d) Discharge Double-blind Premedication: none (e) PONV Procedures: gynaecological laparoscopy Raw data not given Age: 19–40 years Tang et al., (1) Propofol TIVA, no N 2O (n = 34) (a) Open eyes (a): (1) 5, (2) 4 min Grade I 1999, 129 USA (2) Propofol TIVA, N 2O (n = 35) (b) Orientation (b): (1) 6, (2) 4 min Method of RCT randomisation: N 2O: given in group 2 (c) Sit unaided (c): (1) 15, (2) 14 min computer-generated random numbers Premedication: none (d) Stand (d): (1) 24, (2) 21 min unaided Double-blind Procedures: not reported (e): (1) 26, (2) 21 min (e) Street-fit Gender: not reported (f): (1) 2%, (2) 1% (f) PONV Mean ± SD age: 57 ± 18 years No results significant continued 135
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Which anaesthetic agents are costef
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Which anaesthetic agents are costef
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NHS R&D HTA Programme The NHS R&D H
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Contents Appendix 6 Adult patient-b
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Background The aim of the project w
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• The incidence of PONV was low d
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2 Introduction dizziness or disorie
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4 Introduction a reduced incidence
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6 Introduction willingness to pay f
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8 Literature review included in the
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10 Literature review TABLE 1 Compar
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12 Literature review intermediate a
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18 Literature review Patient-based
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20 Literature review TABLE 5 contd
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22 Literature review No studies fol
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24 Literature review (30%) and meth
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26 Literature review • There are
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28 National survey of anaesthetic p
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36 Economic evaluation methods (inc
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38 Economic evaluation methods The
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40 Economic evaluation methods Tabl
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42 Economic evaluation methods simi
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44 Economic evaluation methods Prob
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Recruitment to the CESA RCT The stu
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Clinical outcome data PONV by anaes
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The findings from the logistic regr
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TABLE 29 The length of stay and pri
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140 120 100 80 60 40 20 0 No. of pa
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250 200 150 100 50 0 No. of patient
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TABLE 37 Deterministic sensitivity
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20 15 10 5 0 -5 Difference in varia
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Patient admitted for day surgery an
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500 400 300 200 100 0 -100 -200 -30
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Recruitment to the CESA RCT The stu
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TABLE 49 The occurrence of any PONV
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60 50 40 30 20 10 0 No. of patients
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a scale effect for scenario A, but
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The mean CVs for avoidance of PONV
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1.80 The new variable cost and tota
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100 90 80 70 60 50 40 30 20 10 0 Su
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The structure and content of this d
Page 97 and 98: nurses to have an in-depth knowledg
Page 99 and 100: agent used (see appendix 18). It wa
Page 101 and 102: Furthermore, anaesthetists operate
Page 103 and 104: The CESA project was designed to as
Page 105: practice, such as the use of midazo
Page 109 and 110: 1. Royal College of Surgeons of Eng
Page 111 and 112: 60. Cheng KI, Chu KS, Fang YR, Su K
Page 113 and 114: 112. Raeder J, Gupta A, Pedersen FM
Page 115 and 116: 162. Viitanen H, Baer G, Annila P.
Page 117 and 118: 220. Rosenberg KM, Bridge P, Brown
Page 119 and 120: The range of databases interrogated
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Page 124 and 125: 110 Appendix 2 TABLE 65 contd Summa
Page 126 and 127: 112 Appendix 3 Quality assessment o
Page 173 and 174: TABLE 69 Summary of paediatric pati
Page 175 and 176: TABLE 69 contd Summary of paediatri
Page 177 and 178: TABLE 70 Characteristics of cost or
Page 179 and 180: TABLE 71 Quality of cost or economi
Page 181 and 182: TABLE 71 contd Quality of cost or e
Page 189 and 190: Abbott J, Abbott P. Psychological a
Page 191 and 192: Hall JE, Stewart JIM, Harmer M. Sin
Page 193: Struys M, Versichelen L, Thas O, He
Page 196 and 197: 182 Appendix 11
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184 Appendix 11
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186 Appendix 11
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188 Appendix 11
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The aim of this study was to develo
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anaesthetics in day surgery, using
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© Queen’s Printer and Controller
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Background The empirical study quan
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Satisfaction with care Nearly all (
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TABLE 76 Reason given for preferenc
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TABLE 79 Comparisons with previous
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TABLE 80 Reason given for preferenc
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TABLE 81 Reason given for willingne
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Background Variable costs account f
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TABLE 85 Unit costs for the purchas
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Background The empirical study requ
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Ethical approval This was covered b
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20 15 10 5 0 -5 -10 -15 True weight
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15 10 5 0 -5 -10 True weight - Dion
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224 Appendix 19 • patients aged o
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All staff unit costs were for the y
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Background Fixed costs account for
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232 Appendix 22 March, Tuesday 15 A
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234 Appendix 23 TABLE 96 Reasons fo
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Patients were coded using the OPCS
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Q03.4 punch biopsy of cervix Q03.5
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This section displays the associati
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given in Table 103 confirm the age
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TABLE 107 Occurrence of PONV by dur
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248 Appendix 27 TABLE 113 Frequency
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This section displays the associati
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The adverse events observed in the
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262 Health Technology Assessment Pr
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264 Health Technology Assessment Pr
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